Unrelated Future Costs and Unrelated Future Benefits: Reflections on NICE Guide to the Methods of Technology Appraisal

Morton, Alec; Adler, Amanda I; Bell, David; Briggs, Andrew; Brouwer, Werner; Claxton, Karl; Craig, Neil; Fischer, Asja; McGregor, Peter; Baal, Pieter van

doi:10.1002/hec.3366

Cited by 25 publications

(31 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Costs that are considered to be unrelated to the condition or technology of interest should be excluded . By extending the remit of costs to include unrelated costs, which many authors have argued is appropriate to do [55][56][57], the practical challenge of appropriately estimating any changes in costs over time is magnified, by the simple fact of having more relevant costs to include in the calculation of total costs.…”

Section: Discussionmentioning

confidence: 99%

How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis

et al. 2017

View full text Add to dashboard Cite

Costs and utilities are key inputs into any cost-effectiveness analysis (CEA). Their estimates are typically derived from individual patient level data collected as part of clinical studies whose follow up duration is often too short to allow a robust quantification of the likely costs and benefits a technology will yield over the entire patient's lifetime.In the absence of long-term data, some form of temporal extrapolation -to project short-term evidence over a longer time horizon -will be required. Temporal extrapolation inevitably involves assumptions regarding the behaviour of the quantities of interest beyond the time horizon supported by the clinical evidence.Unfortunately, the implications for decisions made on the basis of evidence derived following this practice and the degree of uncertainty surrounding the validity of any assumptions made are often not fully appreciated.The issue is compounded by the absence of methodological guidance concerning the extrapolation of nontime to event outcomes such as costs and utilities. This paper considers current approaches to predict long-term costs and utilities, highlights some of the challenges with the existing methods, and provides recommendations for future applications. It finds that, typically, economic evaluation models employ a simplistic approach to temporal extrapolation of costs and utilities. For instance, their parameters (e.g. mean) are typically assumed to be homogeneous with respect to both time and patients' characteristics. Furthermore, costs and utilities have often been modelled to follow the dynamics of the associated time-to-event outcomes. However, cost and utility estimates may be more nuanced, and it is important to ensure extrapolation is carried out appropriately for these parameters. Key points1. Need to consider how costs and utilities are extrapolated in a cost-effectiveness model 2. There is no guidance on methods for extrapolating costs and utilities 3. Existing applications use various approaches with little justification

show abstract

Section: Discussionmentioning

confidence: 99%

How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…However, key to understanding this logic is that including future unrelated costs leads to different choices that on balance result in more health benefits [12]. Intuitively, including the costs of unrelated medical care makes sense as they also contribute to the health gains which are implicitly included in practice [5]. By neglecting unrelated future costs, life-prolonging technologies appear to be more cost-effective than they truly are.…”

Section: Box 1: Unrelated Costs and Individual Decision Makingmentioning

confidence: 99%

“…The point we want to take issue with, in particular, is the handling of "unrelated future medical costs" in cost effectiveness analysis. These are now explicitly excluded from these analyses in current guidelines, but, as we will argue, they should be included to support better decisions [5].…”

Section: Introductionmentioning

confidence: 99%

Future unrelated medical costs need to be considered in cost effectiveness analysis

et al. 2018

Self Cite

View full text Add to dashboard Cite

New medical technologies that prolong life result in additional health care use in life years gained. Some of these costs in life years gained are considered to be related to the intervention while other costs are considered unrelated. Here, we argue that ignoring these so-called future medical costs in cost effectiveness analysis is contrary to common sense, results in lost health and fails to inform decision makers for whom cost effectiveness is supposed to serve.

show abstract

“…For example, when assessing the cost effectiveness of heart surgery, the costs related to treating hip fractures in gained life-years after successful heart surgery are also to be included. These costs were explicitly excluded from consideration in the previous guidelines, and this is still the case in most other guidelines, including those of NICE [14]. The inclusion of these latter costs has been much debated [15], but the case for their inclusion is strong [16].…”

Section: Inclusion Of Indirect Medical Costs In Life-years Gainedmentioning

confidence: 99%

From Good to Better: New Dutch Guidelines for Economic Evaluations in Healthcare

2016

Self Cite

View full text Add to dashboard Cite

Unrelated Future Costs and Unrelated Future Benefits: Reflections on NICE Guide to the Methods of Technology Appraisal

Cited by 25 publications

References 20 publications

How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis

How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis

Future unrelated medical costs need to be considered in cost effectiveness analysis

From Good to Better: New Dutch Guidelines for Economic Evaluations in Healthcare

Contact Info

Product

Resources

About